17 July 2009

Long, long ago, when I was a medical student, we joked that you could tell how senior a physician was by how much junk was in their lab coat pockets. As students, we tended to carry around big bags full of every medical gadget we could think of, plus a few reference texts. The attendings were slim and graceful in their long white coats with empty pockets.

When I became an intern and moved into the hospital full-time, all that crap became just too much to lug around. I ditched the bag, and my short white coat (with interior pockets, thank god) became loaded down with tons of stuff: reflex hammers, pocket reference guides, photocopied research papers for reading, patient lists, a procedure log, a PDA with epocrates, a bit of a snack maybe, and more. The coat weighed at least ten pounds fully loaded. As a junior resident, I pared it down to the few references and gadgets I actually used frequently, and the coat got a lot lighter. With each succeeding year I have lightened the load somewhat, down to the absolute essentials. I shed the white coat years and years ago. Now the only things I bring with me to the hospital are:

Three items. It's very liberating. Of course, I have epocrates and more on every computer workstation, so the references are there in the ER for me, but still, it's something of a victory over inanimate junk and my own packrat tendencies that I can go to work with only three things in my pockets.

The downside is that if I happen to forget any one of these three sacred totems, it totally ruins my whole day.

I was all set to go get a dog tag, but I need the left hand to hold the horse.

The amount of stuff I carry in my pockets varies by my mood and how rushed I am to get out of the car (I sometimes have to go fishing on the floor of the car for smaller items). My main items:- stethoscope- thermometer (Vicks bendy 7-second kind, for the wiggly horses)- bandage scissors- pen (in my book, being lucky means that it still has ink)

Optional/may be picked up during the shift:- 1" white tape (a coveted and elusive item that central supply is notoriously stingy with, a complaint for another day -- we retaliate by going and stealing it from the main treatment room, where they hoard half a dozen rolls in each cart and never use them)- extra thermometer covers- hep flush (10 cc)- alcohol swabs- assorted needles (mostly 23x1") - you never go to a battle, er, venipuncture on an angry foal without backup needles (and possibly a helmet and life insurance policy, depending on the size of the munchkin)- blood tube(s)- change for the vending machine

I used to have hemostats and suture scissors, but I lost them last time I moved. I guess I should get new ones, but I'm become very proficient at removing catheters with bandage scissors, and, no, I do not cut the skin. (In horses, the catheter and a short extension set are always sutured in place. Sometimes repeatedly. Nothing like walking by to check fluids and finding that the stall looks like a mass murder scene and the horse is standing there with an innocent look on his face, his extension set a-flapping in the breeze. Good thing it's VERY hard to give a horse an air embolism they'll notice.)

Many nurses are the same. Now all I carry is my 'scope, a couple of pens, badge and forceps with tape and bandage scissors, oh and calipers. The only thing that doesn't live in my locker is my badge. Makes life so much easier.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

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